“…Compared with survivors, age of the population (78 vs 64 yr), underlying severity of illness (Sequential Organ Failure Assessment score: 12 vs 9), comorbidities like active hematological cancer (17% vs 6.8%) and liver disease (29% vs 14%), prevalence of pneumonia (56% vs 38%), and intra-abdominal sepsis (25% vs 18%) were significantly higher in the nonsurvivors. Thus, plausible mechanisms behind the observed albumin trends in nonsurvivors could be high protein nutrition therapy, enhanced hepatic albumin synthesis (acute phase response), and resuscitative measures like hyperoncotic albumin infusions, blood products, or fluid resuscitation leading to PA enrichment by interstitial washdown and enhanced vascular refill of albumin by lymphatics (7). Additionally, host response in sepsis is heterogeneous involving a complex interplay between pro-and anti-inflammatory pathways and may not have a uniform albumin kinetics.…”